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Miscarriage: What No One Talks About

“There is nothing to writing.

All you do is sit down at a typewriter and bleed.”

Ernest Hemingway

I had my miscarriage the day before Christmas – and continued to bleed quietly throughout the Christmas dinner. I ate two pieces of turkey, participated in a conversation and gift exchanges by the tree. I watched our two-year-old daughter laugh and unwrap her presents. But I wasn’t fully there, my mind – a sinking ship, my body – a wreck already. The worst part, I had no idea that this was just the beginning of it.

What kind of word is it – a “miscarriage”? As if I carried something, something precious, but I wasn’t careful enough and I spilled it. As if it is my fault – I miscarried. My own negligence has brought this on me. The mind races on. Have I caused it? Was it the feta cheese from a dodgy Greek place? Was it a few extra cups of strong tea? Was it when I laid down on my belly accidentally, forgetting that I shouldn’t? Was it my fault?

It took me a long time to write about it, pulling a sentence after sentence out of my heart.

Now, because I am writing this and you are reading this, you know it is over. That probably means all kinds of things are back on the table. I can drink as much tea as I wish, I can eat sushi, eggs benedict and medium-rare steaks. I can eat tons of unpasteurized brie and feta cheese. I can lay on my belly all I want. I can even take up kickboxing or do inverted yoga poses. I can even have wine if I so wish (although I haven’t had a drink in three years). The world is full of opportunities! All of them I can indulge in any moment now. Just don’t mind the gapping hole in my soul as I do.

You never think this would happen to you. And then it does.

It is a hell of a lonely place to be at. No one talks about the pain, emotional and physical, that women endure in miscarriage. This is not exactly a dinnertime conversation. But with how common this heartbreaking experience is (1 in 5 pregnancies!), it startles me: there is a cone of silence, an utter isolation of pain that comes with this loss. I want to talk about it because I believe that talking should be an option. I want people to know that even if the pain is invisible, it doesn’t mean it is not there.

Here is a story about 5 weeks of personal hell. Be advised: some gory details ahead.

Week 1

I am feeling great as I go for my first ultrasound. I am 11 weeks pregnant and it is my second pregnancy. The ultrasound tech is chatting me up the whole time and I now know why: she just doesn’t want me to ask questions that she can’t answer.

Then a doctor walks in. This is when I know something is not right. He sits down: “I am afraid I don’t have good news”. He says it just like they say in the movies, except with very little compassion on his stubbled face. He looks at us, all three of us: “There is no heartbeat. The fetus has died”. I turn to look at the monitor, I see my name in white letters, my date of birth – and nothing else. Blackness. “Take your time”, he says. He is in a rush to leave, he doesn’t want to be in a room that is quickly filling up with heartbreak.

How did it happen?! I am wearing my pregnancy leggings, my belly has already noticeably popped out. I have even bought some baby clothes already… How can it be that I now have a dead baby inside of me? A heartbreak of this scale, something I could never imagine, is almost impossible to describe. It is another reason why I wanted to write about it – to attempt to describe the unimaginable, to give the voice to a silent pain.

I am a vessel of life, for goodness sake – how did I become a coffin with my unborn baby inside?

I cry for the next two days until I see my doctor, an OB. The doctor is tall and kind. I can see that he has seen his share of heartbreak in this job. He talks to me quietly. He says, no one knows exactly why miscarriages happen. Approximately every fifth pregnancy ends in a miscarriage, and the causes of it are not fully understood. It is pretty much a lottery of factors: chromosomal abnormalities, lifestyle, genetics. Most likely, in the first trimester, it is the chromosomal abnormality incompatible with life, he says.

What happened to me is called a “missed” miscarriage, or sometimes even a “silent” miscarriage. The fetus has stopped developing (this is my way of saying “the baby has died” without saying these exact words) – but my body didn’t get the memo. It kept going on, continuing to flood my bloodstream with pregnancy hormones for five more weeks after the fetus died. The cord and the placenta kept growing, pumping blood and nutrients to a still little creature inside. A product of conception, this is what the doctor calls it. A euphemism that is supposed to make this experience more manageable. As if there is something, anything, that can.

The doctor says, we need to do the blood work and another ultrasound in a week (a whole week!) to ensure there is no change or an error. I can’t fathom a whole week of being in limbo, waiting for the final verdict. I drive to the lab where they draw my blood. I am biting my lips as they take a vial of my blood and give me band-aid with a picture of Garfield. A fat happy smiling cat. I am crying as I am driving home, wondering if I can smile again.

Week 2

It is a very long week. I grieve over my loss, but I also think of all other losses that women experience in pregnancy: a loss at a later stage in pregnancy, a loss in labour, a stillbirth, a neonatal death. I am telling myself my situation could have been so much worse. But it is not much of a reconciliation, because beyond my own sorrow I see the boundless river of sadness, all the unseen pain that people are so afraid to talk about.

I go for the second ultrasound alone. I hear a Christmas song on the radio as the sonographer pokes me, looking for a non-existent heartbeat. I know it is not there. All I do is tell myself that I can survive this, not sure how yet, but I can.

The doctor comes in, a different doctor this time. He says: “I am sorry”. I feel that he really means it. I go for another round of bloodwork. A pile of ice collapses on my heart when they ask me if I am pregnant. I whisper quietly: “A miscarriage”. In this moment, I understand why it is such a taboo topic: it is almost unbearable to talk about it.

I then stop by my doctor’s office. “It is confirmed now”, he says. “There is no growth and no change. It is indeed a failed pregnancy”. I have options now. Now we can act, I can finally get out of the limbo and experience the physical loss. My options are to wait, take a pill or have a surgery. I have just been through an agonizing week of waiting, so waiting is not an option, especially with a growing risk of infection. I want to avoid surgery unless absolutely necessary, as it comes with a longer recovery and a general anesthesia.

I choose the pill, or what is called a medication management. The drug is called misoprostol, it causes the uterus to contract and expel what is inside. The doctor stops me at the door: “With a pill, there is a lot more pain and bleeding than you expect. Be prepared”. I am prepared for anything – to me, no physical pain can measure up to the emotional pain.

I take pills in the morning. They work fiercely. They bring on contractions – at first gently, like distant waves, then it builds up. It reminds me of the beginning of labour. But it grows and gains momentum as the day progresses. By dinner time, the contractions and pain become extreme, even with painkillers. My uterus goes in the overdrive, contracting, squeezing, pumping out blood at a frightening rate. I breathe through contractions, just like I did in labour. But it barely helps – the miscarriage pain is so much worse than labour pain. Labour brings on a child, it resolves in a new life. In miscarriage, there is nothing but pain and suffering, and then some.

By the time my daughter goes to sleep, the worst pain arrives. I scream into the pillow. There is blood everywhere – on the carpet, on the floor, on my hands, on the bath mat. It is pouring out like from a tap.

The way we see miscarriages in movies is horrific, but it is not entirely accurate: a girl wakes up in the middle of a night in a puddle of blood, or she cringes on a cold tiled floor of a bathroom. The movies don’t show the pain. Moreover, they don’t show the main part. You see, it is not just blood that comes out. It is also the “tissue”. Chunks of flesh, my own and baby’s. Some pieces are as big as a palm of a hand. They splash into the toilet. A gestational sac with a fetus, parts of an umbilical cord, chunks of placenta – all these things that were never meant to be seen. This is the moment where I think I would lose my sanity. An experience like this rips a soul apart – and at this point I am not sure my soul would ever recover. In a retrospect, I certainly lost a part of my normally happy self right then and there. An experience like this you can’t un-see and un-live it. But somehow you would have to recover…

By 11pm it all seems to be over. Pain subsides, bleeding reduces and I pray that this is the end of it. I can’t fathom that there is anything left in me – in my uterus or in my heart.

But I was wrong – it was not over yet.

Week 3

I continue to have contractions, bleed and loose a piece of “tissue” every once in a while. It is a week before the New Year’s Eve and everything around is glowing with joy and bright lights. It shines so bright that it hurts. It strikes me how painful the holiday season can be for someone who is suffering. There is a too great of a contrast between the joy around and the darkness inside.

We go out to Christmas dinners, family gatherings, restaurants, Christmas markets. We make sure we act like the life goes on, although it doesn’t feel this way. We do it for our daughter – laying in bed is not an option when you have a toddler. We take our daughter to the parks. We make sure she doesn’t see my tears. She laughs and plays in the snow. I follow her with a smile on my face and a giant pad in my underpants to absorb the bleeding that doesn’t seem to taper off. Is there a pad for my bleeding soul, too? I would like a pack of those, please, in size XL.

It continues throughout the New Year’s Eve. We greet 2018 with a glass of a non-alcoholic champagne and a movie about Nepal. I kiss my husband on a cheek – my kind, strong, beautiful husband who has been with me through all this pain – and I crawl off to bed, next to my sleeping daughter. I listen to her breathing peacefully and I hear the fireworks going off in the distance. I hope these don’t wake her up. I realize that I didn’t make a wish this year.

Week 4

I go for another ultrasound appointment. The goal is to make sure that the miscarriage is complete and there is nothing left. I agonize for another few days waiting for the results. At the doctor’s office there is a black-and-white photo of the smiling babies on the wall. It hurts to look at, just like everything else around me does – pregnant women, newborns, young siblings walking with their parents.

The news isn’t good: the pill didn’t do its job properly. My miscarriage isn’t complete. In other words, there is still some “tissue” left inside. My uterus has been ravaged, but it isn’t quite vacant yet.

The doctor asks if I want a surgery, now that I have been through the horrors of medicated miscarriage. I say “no”. I do understand why women opt out for surgery right away, but I want to give my body a chance to have a closure as close to natural as possible. I don’t want surgery unless there is another option, so I pick up the pills. Seeing these six white tablets makes me shiver – I know what I am in store for.

This would have been week 13 of my pregnancy. The pregnancy that failed – and a miscarriage that failed to complete. I make a great effort not to think in terms of failure/success. I concentrate on getting through it. And I am begging my body to let go: I know there wouldn’t be a round three of pills, if this time it doesn’t work. I know the next step would be a OR for me, and I don’t want to go there.

My body has heard me. I woke up at 5am the next day with strong contractions and bleeding. A part of me is glad: now I don’t have to take the damned pills! My body went into a natural miscarriage and hopefully that completes the process. The natural miscarriage is less painful than the medicated one. It is less gory and I don’t cringe in pain as much. It is over in about an hour. I am sitting on the couch with a cup of tea by the time my daughter and husband wake up. I am pale, tired, but hopeful. I think it is done now. This must be the end of it.

But I was wrong, again.

I go for an ultrasound in a couple of days. The doctor calls me right away and says: “Olga, unfortunately, there is still tissue left. There is not much, but there is still some. What do you want to do now?”.

I can’t believe it. I now have suffered two miscarriages in two weeks, one medicated and one natural. After four weeks of pain, bleeding and heartbreak, how can it keep going on?

By that point, I am devastated mentally and physically. I have a choice: a surgery, meaning weeks of recovery, or pills, meaning a day of pain, bloodbath and shitting body chunks out of my vagina. I can’t go through it again. I want to start grieving and moving towards healing – all the things that I haven’t been able to do yet. I want a closure and if that closure happens in the bright light of the OR, then be it. “Talk me through the surgery”, I say.

Week 5

I change into a hospital gown. The linen is white-blue, washed and bleached too many times. I put on synthetic green socks and plastic shoes. The floor is slippery and very, very clean. I brush my teeth and rinse my mouth. I take off all my jewelry, piece by piece, even the silver bracelet that my Dad brought me from Africa, the one that I never take off.

I am shaking. I am wondering if there is a single person who can sit in a surgery waiting room and not contemplate their own mortality. I think of my daughter. I am afraid that if something goes wrong, I would never get to see her again. I am crying. I am aware that my anxiety is spinning out of control – the last few weeks did a number on me, and I don’t have much left to resist. There is The Simpsons on the TV in the corner. I hate The Simpsons, and I will even more now that I have seen them here, at the hospital. They put a blue hat on my hair and an IV into my left arm. I keep crying as they wheel me on the stretcher into the shiny bright OR. My husband is left behind and I am afraid to turn and look back at him for another glance.

…I listen to the beeping sound of my pulse on the monitoring machine. The surgery was quicker than I thought, I was awake and even strangely comfortable throughout it, thanks to the drugs. I am shivering now – this is partially due to the spinal block anesthesia wearing off and partially because my soul is coming back to my body. I know everything is over, but I don’t feel instantly better, like I thought I would. There is a clock right in front of me. I watch the small hand move slowly from four to eight pm. Once I can move my legs and walk on my own, they will let me go home. The surgery went well, the doctor says as he stops by to check on me.

My body is empty. My uterus is void. I feel like a house that has been robbed. The doors are locked, the windows are dark. Do not disturb, says the sign on the door, healing in progress.

***

These five weeks have been hell, and I am still not fully recovered from it. It will take time to rebuild happiness and my capacity for it, to take control over my fears and anxiety and to be able to find some much needed inner peace. I have embraced my loss, but I am yet to recover from the traumatic effects of it. As I heal, I am thinking of all women who have gone through it before and who are going through this pain right now, alone, in emotional isolation, with unshared suffering and pain. There are so many shades of human suffering; and while suffering is not optional, keeping it in silence and thus multiplying it – should be.

In a world where women speak up about abuse and harassment now more openly than ever, we still don’t talk nearly enough about other types of pain that we endure. Prior to this experience, I thought of girls who have had a miscarriage with a lot of sadness and even a pity in my heart. Now that I have lived through it, I feel sadness, but also a great deal of frustration and empowerment to bring this forbidden subject out there. Or at the very least to make it OK to talk about it. Because no matter how we choose to suffer and grieve, in silence or surrounded by people, we should never feel ashamed or scared to talk about what we go through. It doesn’t make it more likely to happen if we talk about. Miscarriage is not a flu, it is not contagious. But sharing the pain makes it feel a little bit more manageable, especially in a world where pain and being a woman are so closely related.